Health Information Management

Tip: Use modifier -58 instead of modifier -59 when appropriate

APCs Insider, September 7, 2012

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Modifier -59 (distinct procedural service) should always be the modifier of last resort. Before appending modifier -59, coders and billers should first check that no other ­modifier will better describe the patient’s situation. If a better modifier exists, use it.

In some cases, coders will append modifier -58 (staged or related procedure or service by the same physician during the postoperative period) instead of modifier -59. Modifier -58 indicates that a procedure was followed by another procedure or service during the ­postoperative period. This may be because it was planned ­prospectively, because it was more extensive than the original procedure, or because it represents therapy after a diagnostic procedural service.
For hospital outpatient billing, coders and ­billers should only use modifier -58 on the same date as the original procedure. The modifier becomes unnecessary later.
Be sure to read the individual chapter guidelines closely to ensure correct use of modifier -58. Proper use can be tricky.
For example, a patient undergoes a breast biopsy. The surgeon sends the biopsy for a frozen section, then performs a mastectomy based on the biopsy results during the same operative session. In this case, modifier -58 should be appended. That way the facility receives payment for the biopsy instead of it being bundled into the mastectomy.
The tip is adapted from “Simplify the decision to use modifier -59” in the August Briefings on APCs.

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